Meeting the end-of-life needs of the homeless and vulnerably housed: Taking palliative care to where patients are
Toronto, June 25, 2014
By Dr. Naheed Dosani
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Dr. Naheed Dosani, Inner City Health Associates, and staff physician, Palliative Care
There is alarming data and information coming out of our homeless shelter systems:
- Average life expectancies for homeless persons are estimated to be between 34 and 47 years
- Mortality rates among homeless populations are 2.3 to four times higher than the general population
- Despite exhibiting signs and symptoms of extensive disease, homeless individuals often do not receive end-of-life care because of their immediate environment
- Many health care and social service providers feel that mainstream palliative care services are generally inaccessible to homeless populations
- Despite a keen interest in advanced care planning and specific preferences for location of death, 34 to 59 per cent of the time, homeless patients die in acute-care hospital settings
Through the launch of a new pilot program starting this July, I’ll be heading out into the community with a team of health care professionals to provide palliative care to patients who are homeless and vulnerably housed. Our new program, called PEACH (Palliative Education and Care for the Homeless), is an initiative of the Inner City Health Associates. We are a group of more than 60 physicians working in shelters and drop-in sites to provide care to homeless and marginally housed individuals in Toronto. The PEACH initiative aims to bring interdisciplinary palliative care to these patients who represent one of our most vulnerable and marginalized populations, by meeting patients wherever they may be. By this, I mean two things:
- Geographically. Traditionally in palliative care, we’ve required patients to visit us in clinics, receive us in their homes, or be in a hospital or hospice bed for us to provide appropriate end-of-life care. Unfortunately, for vulnerable populations, such as patients who are homeless or suffering from a mental illness, this doesn’t always work. Our mobile, shelter-based program will be going into the community to meet patients with serious illnesses, wherever they are located. By providing increased community resources and supports to our partners within the shelter system, we hope to meet the end-of-life wishes and preferences of our patients so that they may receive the care they need with respect and dignity.
- Medically. For a variety of reasons, the early identification of palliative care needs among vulnerable populations is relatively uncommon. There is increasing evidence that the provision of early palliative care, even as soon as someone is diagnosed with a terminal illness, should be a priority for all. Through PEACH, we aim to meet the needs of patients wherever they may be, along the trajectory of their disease process. As part of this, we hope to provide early and upstream palliative care integration to ensure access for all patients, not just for those who have been admitted to a hospital. This will allow us to better manage pain and symptoms, provide psychosocial supports and appropriately meet the goals of care of such patients. To our knowledge, PEACH will be the first service to apply early palliative care to a vulnerable patient population.
We are also interested in education around palliative care and homelessness – being a resource to health care providers who may care for homeless and vulnerably housed patients. Through this pilot program, we hope to gain insight into some of the unique challenges of providing palliative care services to homeless and vulnerably housed individuals and further develop best practices for how to better address their needs.
A community-based outreach program such as PEACH requires dedication, commitment and strong support from the palliative care community in the GTA. We are thrilled to be collaboratively partnering with the Toronto Central CCAC, Toronto Grace Health Centre, Mount Sinai Hospital’s Temmy Latner Center for Palliative Care and St. Michael’s Hospital’s Palliative Care Unit.
Naheed Dosani is a palliative care physician with the Inner City Health Associates. Follow Naheed on Twitter: @NaheedD.
The Inner City Health Associates are a group of physicians who work with those who are homeless in Toronto. Our vision is to help end homelessness by providing specialized health care and health related programming in the community. We include physicians with backgrounds in family medicine, psychiatry, internal medicine and community medicine. Services and programming are provided in various locations including shelters, specialized clinics, drop in centres and related settings.
About St. Michael's Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.